BIRMINGHAM CHILDREN S HOSPITAL NHS FOUNDATION TRUST Specialty Registrar PAEDIATRIC EMERGENCY MEDICINE BIRMINGHAM Birmingham is a progressive, modern city offering pleasant accommodation and excellent civic infrastructure. There are good road, rail and air links and easy access to the countryside. The International Convention Centre, Symphony Hall, National Indoor Arena, the Art Gallery and several theatres are centrally located. There are excellent schools and the Universities of Birmingham, Aston and Birmingham City University offer a wide range of educational facilities and other activities. THE BIRMINGHAM CHILDREN'S HOSPITAL NHS FOUNDATION TRUST The Birmingham Children s Hospital NHS Foundation Trust comprises: The Diana, Princess of Wales Children s Hospital, Birmingham Child and Adolescent Mental Health Services (CAMHS) for the whole of the city The Children s Hospital moved to a new site at Steelhouse Lane in the centre of the city in May 1998. This marked the culmination of a long history of planning for a new Hospital to replace the overcrowded facilities at its previous home in Ladywood. The relocation involved a 30 million redevelopment of the previous Birmingham General Hospital site and has created a large, multidisciplinary, dedicated Children s Hospital with a capacity for almost 300 beds. Redevelopment included the construction of a new three-storey block which houses radiology, a 20 bed intensive care unit and four of seven operating theatres. In addition to upgraded clinical facilities, the site includes a parent accommodation block (Edward House), the James Brindley Hospital School and an Education Centre. The Trust was awarded Foundation status in February 2007 and has recently been achieved Excellent for both quality of services and use of resources in the Healthcare Commission annual ratings for 2006/07. The Trust provides secondary level paediatric services for the child and adolescent population of much of the city of Birmingham, both in the hospital and through a number of outlying sites. It is also the regional referral centre for the West Midlands region (population 5.2m) and many of its specialist services extend their referral base beyond the regional boundaries. In addition to General Paediatric Medicine and General Paediatric Surgery, the clinical services provided by the Trust include: Emergency Medicine, Anaesthetics and Intensive Care, Bone Marrow Transplantation, Cardiology and Cardiac Surgery, Child and Adolescent Mental Health, Clinical Psychology, Dermatology, Endocrinology and Diabetes, ENT Surgery, Audiology and Cochlear Implantation, Gastroenterology and Clinical Nutrition, Haemophilia, Hepatology, Inherited Metabolic Disease, Neonatal Surgery, Nephrology including Haemodialysis and Renal Transplantation, Neurology, Neurophysiology, Neurosurgery, Non Malignant Haematology, Oncology, Ophthalmology, Orthopaedic and Trauma Surgery, Paediatric Dentistry, Plastic Surgery including Cleft Lip and Palate Surgery and Burns Surgery, Rehabilitation, Respiratory Medicine and Cystic Fibrosis, Rheumatology and Thoracic Surgery. The Children s Hospital is 1
also a designated supra regional centre for Craniofacial Surgery, Complex Liver Disease and Liver Transplantation, and is currently designated as the only national centre for Paediatric Small Bowel Transplantation. The new Burns project has been completed and provides ward and theatre accommodation and this development has also allowed the Trust to expand the Education Centre and Outpatient facilities. There is comprehensive provision of diagnostic and support services including all aspects of paediatric laboratory medicine, radiology and pharmacy. Therapy services include dietetics, physiotherapy, orthoptics, occupational therapy, and speech and language therapy. Pastoral and social support is offered by a multi-faith chaplaincy, the bereavement support team and by the social work department. Ambition Statement Caring for Children, Young People and their families Our Core Purpose: To lead exceptional services for the health and well being of every child and young person Our Core Values: We are Focused on, Caring for and Committed to children and young people. Our Audacious Goals: The West Midlands will have the healthiest children and young people in the United Kingdom We will be a partner of choice Children and young people will be healthy, protected, educated, and treated with respect We will be an international leader of children and young people s healthcare EDUCATION AND RESEARCH DIRECTORATE A Directorate of Education and a Directorate of Research have been established in order to consolidate and support education and research initiatives within the Trust. The Directorates include the Professional Development Team, Organisational Development and Training, Medical Education and Research and Development. The Education Directorate is led by Mr Garrett Taylor. Dr Clive Ryder, Consultant Paediatric Rheumatologist, is the Postgraduate Clinical Tutor and Head of Postgraduate Medical Education. The Research Directorate is led by the Director for Research and Development, Dr Bruce Morland. The Research and Development Department manages research in the Trust and is responsible for research governance, including research ethics issues. This includes managing research finances, ensuring drug trials are carried out to international standards and coordinating laboratory involvement in research. The Department also co-ordinates an R&D education programme within the Trust and provides guidance for developing and registering research projects, research design, statistical advice and data analysis, including laboratory coordination of samples and pharmacy support for clinical trials. 2
THE ACADEMIC DEPARTMENT OF PAEDIATRICS The University Academic Department of Paediatrics and Child Health (Head of Department - Professor Tauny Southwood) is part of the Division of Reproductive and Child Health. The Academic Department is situated in the Clinical Research Block, Whittall Street, adjacent to the Children s Hospital in the centre of Birmingham. DEPARTMENT OF PAEDIATRIC EMERGENCY MEDICINE Staff Consultants Associate Specialist Specialty Doctors Specialist Trainees (ST4-7) Specialist Trainees (ST2-3) Clinical Fellow Dr Ben Stanhope MRCP (Clinical Lead) Dr Kath Berry FRCP (Can), FRCPCH,FCEM Dr. Tina Newton FRCPCH Dr Sapna Verma FRCPCH, PGCME Dr Bridget Wilson MRCP Dr Stuart Hartshorn MRCPCH Dr Andy Lewis 4 Posts 1 Paediatric National Grid trainee in PEM 1 Paediatric Specialist trainee 2 Emergency Medicine Specialist trainees 1 ST2 Paediatrics 3 ST3 Paediatrics 2 CT3 Emergency Medicine 1 Post Clinical Fellow (Teaching) 1 Post Secretarial staff Jayne Hughes Dawn Murray DEPARTMENTAL ACTIVITIES The Emergency Department This is the only Emergency Department in the region dedicated to children and approximately 45,000 children are seen annually. The Emergency department rota is a full shift system and is European Working Time Directive compliant. The department is well staffed by experienced nurses. A triage system, observation ward and GP assessment unit are established. 3
The case mix in the department is approximately 60% medical and 40% trauma patients. Approximately 50% of the children seen are under 3 years old and most are brought directly to the hospital by their parents. Over half of all medical admissions to the hospital are accounted for by the self-referred patients to the Emergency Department. The department sees patients from the whole of the Birmingham area but predominantly from the inner city with areas of considerable social deprivation. There is a wide ethnic mix, the predominant ethnic minority being from the Asian sub-continent. Approximately 4500 patients are admitted to the hospital from the Emergency Department (ED) per annum. Acute review clinics for medical problems are held within the department four days per week and twice a week for follow up of soft tissue injuries and minor trauma. Approximately 2,000 per annum are seen in these clinics. The department consists of: 3 bedded resuscitation area 3 high dependency cubicles 4 examination cubicles Minor injuries area Treatment theatre 5 bedded urgent GP referral unit 9 bedded observation/short stay ward Subspecialty training This is a one year post. Three months will be spent working on PICU at Birmingham Children s Hospital (BCH) and 9 months will be spent working in the PED at BCH, with one third of this time spent in general paediatrics according to the needs of the applicant. This will include attendance at paediatric clinics and ward rounds to understand the long term management and follow up of children. Clinical Responsibility The post holder is responsible for the assessment and management of all patients who present as emergencies to the department, except those who have been referred directly to the RMO or RSO on call. Close liaison with the medical and surgical specialists is an important aspect of good clinical practice and the post holder is expected to maintain the established working relationships. The post holder will offer a follow-up review, or refer patients to other hospital specialists or back to the patient s General Practitioner as necessary. It is expected that family doctors and other relevant medical personnel are kept fully informed of their patient s circumstances and progress. 4
Additional Duties The junior doctors accept that he/she will perform duties in occasional emergencies and unforeseen circumstances at the request of the appropriate Consultant. It has been agreed between professions and the Department that while the junior doctor accepts that they will perform such duties, the Secretary of State stresses that additional commitments arising under this sub-section are exceptional and in particular that juniors should not be required to undertake work of this kind for prolonged periods, or on a regular basis. (Extract from DHSS Circular DS278/75). Teaching/Audit There are four hours of protected teaching time each week for attendance at regional teaching.. There are postgraduate meetings within the hospital and teaching sessions preparing junior medical staff for postgraduate examinations. The post holder will work an average of 48hrs per week ( 40 hours clinical, 8 hours protected teaching, audit, research) and this post is paid at Band 1A and is a full shift rota. This post is New Deal and European Working Time Directive compliant PICU secondment The postholder will be involved in management of the sick child on PICU under the supervision of the PICU Consultant staff, and will be trained in the retrieval of sick children. The trainee will be part of the PICU on call and retrieval team, depending on their level of expertise. Training will take account of the experience of the trainee and be tailored accordingly in discussion with the PEM Consultant and the PICU Consultant. Training and educational objectives for the post 1 Gain experience in the multidisciplinary aspect of Paediatric EM including role of primary care support, community nurses, health visitors and social services 2 Understand the wide range of problems presenting via the ED including medical and non-medical ie. orthopaedic, trauma, burns and plastic surgery, and fulfil required competencies To understand the long term management and follow of patients with medical problems and have greater understanding of paediatric pathophysiology 3 Undertake at least one high quality audit project 4 Gain insight into the processes involved with running the department managing complaints, clinical incidents and other risk related issues, managing results, making a business case 5 Attain / renew paediatric resuscitation skills 6 Continue to be trained and teach subjects specific to the PED environment 7 Gain experience in the supervision of junior doctors within the environment of Paediatric ED 5
How these training and educational objectives will be achieved 1 Attending weekly psychosocial meeting within the department with liaison health visitor, social worker, and nursing and medical staff. Involvement by discussion about change in provision of services including the concept of the Urgent Care Centre and Front End of unscheduled care. Attendance at Users meetings. 2 Seeing patients on day to day basis. Attendance at paediatric medical and surgical, as well as subspeciality clinics such as diabetes and sickle cell. Attendance at post take ward rounds and weekly multidisciplinary grand round. 3 Complete at least one project under supervision appropriate to PEM and if appropriate pursue presentation to a wider audience or publication. 4 Supervision and discussion with Paediatric EM consultant, supervised review of results and complaints, involvement by discussion in risk issues and clinical incident resolution 5 Attendance at all Paediatric Arrest and Trauma calls, and acting up as team leader for resuscitation (must be APLS provider). Bi monthly trauma resuscitation scenarios are held in the Paediatric ED for medical and nursing staff which the SpR will be expected to attend and take part in. 6 Shop floor teaching and supervision by Consultants, attendance at weekly sub regional teaching programme, involvement in Friday afternoon teaching programme for junior doctors. 7 Experience on day to day basis, taking part in appraisal with supervision at consultant level. Undertaking workplace based assessments for junior doctors. 6